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Liver Stiffness Elevation in Patients with Heart Failure and Liver Congestion

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Liver Elastography

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Abstract

Right heart failure is closely associated with liver congestion since right atrium and liver are connected by the inferior caval vein. The role of right heart failure on the prognosis has only recently been fully appreciated. Evaluation of right ventricle function is sophisticated due to the complex shape of the right ventricle and technical issues in routine imaging. Studies have demonstrated that liver stiffness (LS) not only correlates with central venous pressure but also with increased right ventricle filling pressure and inversely with TAPSE (tricuspid annular plane systolic excursion) as a parameter of right ventricle function. Most importantly it correlates with morbidity and mortality of patients with heart failure. Consequently, in the absence of other confounding factors (i.e., liver fibrosis/cirrhosis), LS assessment by elastography allows to assess increased pressure in the right heart system. LS cutoff values in heart failure patients resemble very much those in liver fibrosis assessment: (a) LS < 7 kPa normal RV filling pressure and exclusion of RV failure, (b) LS 7–8 kPa: “gray zone”, (c) LS 8–12.5 kPa with increased risk for morbidity and mortality due to heart failure or cardiac death; in case of LVAD-implantation increased risk for RV failure, and (d) LS > 35 kPa with biventricular assist device (BIVAD) needed due to RV failure. Since LS measurements are easy to perform and can be repeated throughout the process of cardiac recompensation, it may be worthwhile to routinely establish elastography for routine evaluation but also management of heart failure patients.

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Authors and Affiliations

  1. Ordination für Gastroenterologie und Innere Medizin, Innsbruck, Austria

    Gunda Millonig

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  1. Gunda Millonig
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  1. Department of Medicine and Center for Alcohol Research and Liver Diseases, Salem Medical Center, University of Heidelberg, Heidelberg, Germany

    Sebastian Mueller

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Millonig, G. (2020). Liver Stiffness Elevation in Patients with Heart Failure and Liver Congestion. In: Mueller, S. (eds) Liver Elastography. Springer, Cham. https://doi.org/10.1007/978-3-030-40542-7_23

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  • DOI: https://doi.org/10.1007/978-3-030-40542-7_23

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